Relationship of stress, distress, and the immunologic response to a recombinant hepatitis B vaccine.

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BACKGROUND: Many studies have investigated the relationship between psychosocial factors and the susceptibility to infectious diseases. Fewer studies have investigated the relationship between stress and the immunologic response to vaccines. A follow-up study was designed to investigate the relationships between stress, distress, and the antibody response to a recombinant hepatitis B vaccine. METHODS: Eighty-one seronegative medical students received a standard immunization protocol of a recombinant hepatitis B vaccine. Six months after the first dose, corresponding to the induction phase of immunization, each subject completed both the Survey of Life Experiences and the Symptom Distress Check List to assess levels of stress and distress during that period. Three months after the third dose, corresponding to the booster phase of immunization, each subject completed the same questionnaires and was also tested for a quantitative hepatitis B surface antibody titer. Correlations were statistically analyzed using Pearson's correlation coefficient and stepwise multifactorial regression analysis. RESULTS: Higher levels of negatively perceived stress, irascibility, depression, and anxiety during the induction phase of immunization were significantly associated with higher peak antibody titers. Together these psychosocial factors accounted for 5.8% of the variance, and were as strong a determinant of peak antibody titer as was age. CONCLUSIONS: In addition to the known vaccine-related and biological factors, psychosocial factors appear to affect the immune response to a recombinant hepatitis B vaccine. The positive direction of the correlation raises the question of whether the effect of psychosocial factors on antibody formation is different from their effect on antibody function.